<form action="" id="pac-form" method="get">
 <fieldset style="padding: 10px">
	<legend>Personal Information</legend>
	<div style="margin: 5px">
		<label for="first_name">First Name</label>:
		<input type="text" id="first_name" size="10" value="Your first name here ..." />
	</div>
	<div style="margin: 5px">
		<label for="last_name">Last Name</label>:
		<input type="text" id="last_name" size="15" />
	</div>
</fieldset>
</form>